1 Table One

Characteristic	MD N = 8081	RN N = 8221
Age	47 (40, 55)	43 (35, 51)
Unknown	42	64
Years Since Training	16 (8, 24)	13 (8, 22)
Unknown	53	79
Gender
Female	210 (27%)	593 (78%)
Male	547 (71%)	152 (20%)
Nonbinary	1 (0.1%)	3 (0.4%)
Gender not listed/prefer to self describe (Please specify):	1 (0.1%)	1 (0.1%)
Prefer not to answer	12 (1.6%)	9 (1.2%)
Unknown	37	64
Race
White	581 (77%)	640 (85%)
Black or African American	20 (2.7%)	28 (3.7%)
Asian	80 (11%)	28 (3.7%)
American Indian or Alaska Native	0 (0%)	5 (0.7%)
Native Hawaiian or Other Pacific Islander	1 (0.1%)	1 (0.1%)
Multiple races	17 (2.3%)	15 (2.0%)
Prefer not to answer	53 (7.0%)	32 (4.3%)
Unknown	56	73
Hispanic
No, not Hispanic or Latino	721 (94%)	705 (93%)
Yes, Hispanic or Latino	49 (6.4%)	52 (6.9%)
Unknown	38	65
RUCA Regions
Urban	743 (93%)	679 (83%)
Suburban	43 (5.4%)	75 (9.1%)
Rural	17 (2.1%)	66 (8.0%)
Unknown	5	2
Magnet Status
Yes	279 (36%)	276 (36%)
No	109 (14%)	413 (55%)
I don't know	381 (50%)	68 (9.0%)
Unknown	39	65
1Median (Q1, Q3); n (%)

2 Distributions of Information Source Use and Quality

2.1 Overall

2.2 By Provider Type

3 Distributions of Organizational Attitudes

3.1 Overall

3.2 By Provider Type

4 Principal Component Analysis

4.1 Variable Loadings

4.2 Scree Plot

4.3 Heatmap

Principal Component Analysis of Clinician Information Sources During the Early COVID-19 Pandemic

We relied on four dimensions, corresponding to: (1) professional networks (e.g., ED leadership, hospital leadership), (2) news and social media (e.g., Facebook, Twitter/X), (3) academic publications (e.g., peer-reviewed journals, society communications), and (4) blogs and podcasts. Only factor loadings greater than 0.5 are noted, representing strong associations between information sources and their respective components.

5 Adoption Patterns

5.1 Adoption of COVID-19 Innovations by Provider Type and Decision-Making Discretion

Number and percentage of clinicians who adopted each innovation, shown overall and by provider type (nurses vs. physicians). Results are presented for all clinicians and for the subset with decision-making discretion for each innovation.

Innovation	Sample	Clinician Type		Total
Innovation Adoption by Provider Type
Number and percentage of adopters
Innovation	Sample	Physicians	Nurses	Total
PPE reuse	All clinicians	729 (93.1%)	731 (93.4%)	1460 (93.2%)
PPE reuse	Flexible for this innovation	305 (89.2%)	153 (85.5%)	458 (87.9%)
High-flow oxygen	All clinicians	690 (88.2%)	555 (71.2%)	1245 (79.7%)
High-flow oxygen	Flexible for this innovation	658 (90.8%)	431 (81.6%)	1089 (86.9%)
Ivermectin	All clinicians	37 (4.7%)	67 (8.6%)	104 (6.7%)
Ivermectin	Flexible for this innovation	30 (5.0%)	29 (15.9%)	59 (7.5%)

5.2 Clinician Ratings of Information Access and Reliability

Clinician ratings of information use and perceived reliability across source categories during early COVID-19 (Mar–Jun 2020). Bars show means by clinician type (MD vs. RN) with 95% CIs; percentages indicate the share who used at least one source per category. Asterisks denote significant differences between physicians (MDs) and nurses (RNs) after Holm correction for multiple comparisons (*** p < 0.001, ** p < 0.01, * p < 0.05).

5.3 Overlap in Innovation Implementation

Venn diagram showing the number and percentage of clinicians with discretion in decision-making who reported implementing PPE reuse, high-flow oxygen (HFO), and ivermectin (IV) during the early COVID-19 pandemic. Overlapping regions indicate clinicians who implemented more than one innovation. Counts and percentages are displayed within each region. Bold labels identify the three innovation categories.

6 Logistic Results

6.1 PPE Reuse

Predictor	OR	95% CI (Lower)	95% CI (Upper)	P-value	OR (Label)
Adjusted Odds Ratios (all)
Professional Networks	0.956	0.530	1.709	0.880	0.96
News and Social Media	2.001	1.235	3.394	0.007	2.00**
Academic Publications	1.516	0.833	2.807	0.178	1.52
Blogs and Podcasts	0.571	0.330	0.976	0.042	0.57*
Age	0.981	0.953	1.010	0.193	0.98
Female (vs. Male)	1.388	0.645	3.092	0.411	1.39
Other or Unknown Gender (vs. Male)	0.444	0.044	10.250	0.523	0.44
Suburban (vs. Urban)	0.387	0.152	1.095	0.057	0.39+
Exurban/Rural (vs. Urban)	1.233	0.519	3.303	0.654	1.23
Perceived Flexibility	0.068	0.023	0.194	0.000	0.07***
Physician (vs. Nurse)	1.732	0.685	4.301	0.238	1.73
Physician x Flexibility	4.376	1.208	16.429	0.026	4.38*

6.2 High Flow Oxygen

Predictor	OR	95% CI (Lower)	95% CI (Upper)	P-value	OR (Label)
Adjusted Odds Ratios (all)
Professional Networks	0.865	0.628	1.188	0.373	0.87
News and Social Media	1.112	0.860	1.452	0.425	1.11
Academic Publications	1.360	0.962	1.930	0.083	1.36+
Blogs and Podcasts	1.192	0.876	1.625	0.264	1.19
Age	0.997	0.981	1.014	0.753	1.00
Female (vs. Male)	1.001	0.661	1.513	0.997	1.00
Other or Unknown Gender (vs. Male)	1.146	0.364	5.097	0.835	1.15
Suburban (vs. Urban)	1.319	0.726	2.577	0.388	1.32
Exurban/Rural (vs. Urban)	1.090	0.667	1.851	0.740	1.09
Perceived Flexibility	1.222	0.741	2.065	0.443	1.22
Physician (vs. Nurse)	1.585	0.965	2.631	0.071	1.58+
Physician x Flexibility	1.582	0.763	3.252	0.214	1.58

6.3 Ivermectin

Predictor	OR	95% CI (Lower)	95% CI (Upper)	P-value	OR (Label)
Adjusted Odds Ratios (all)
Professional Networks	0.551	0.316	0.959	0.035	0.55*
News and Social Media	1.501	1.028	2.170	0.032	1.50*
Academic Publications	1.623	0.896	2.975	0.113	1.62
Blogs and Podcasts	0.893	0.533	1.491	0.666	0.89
Age	1.018	0.990	1.047	0.208	1.02
Female (vs. Male)	1.384	0.688	2.778	0.360	1.38
Other or Unknown Gender (vs. Male)	1.575	0.080	9.852	0.684	1.57
Suburban (vs. Urban)	1.563	0.594	3.628	0.327	1.56
Exurban/Rural (vs. Urban)	1.319	0.582	2.786	0.485	1.32
Perceived Flexibility	0.339	0.129	0.816	0.020	0.34*
Physician (vs. Nurse)	0.307	0.124	0.738	0.009	0.31**
Physician x Flexibility	1.391	0.426	4.767	0.590	1.39

7 Predictors of Innovation Adoption among Clinicians

Forest plot showing adjusted odds ratios (aORs) and 95% confidence intervals for predictors of clinicians’ decisions to suggest or implement three COVID-19–related practices: PPE reuse, high-flow oxygen, and ivermectin. “Perceived Flexibility” reflects increased flexibility among nurses. “Physician (vs. Nurse) reflects the impact of being a physician rather than nurse among clinicians with some flexibility. “Physician × Flexibility” indicates whether the association between perceived flexibility and adoption differed for physicians compared with nurses. For PPE reuse, an aOR of 4.38 (>1) shows that while greater flexibility reduced reuse for both groups, the drop was steeper for nurses than for physicians. Significance: *** p < 0.001, ** p < 0.01, * p < 0.05, † p < 0.10.

8 Clinician-Reported Justifications for Implementing COVID-19 Innovations

Bar chart illustrating the percentage of clinicians with decision-making flexibility who cited each factor as influencing their decision to implement the innovation, grouped by adopters versus non-adopters. Significant differences indicate that adopters were more likely to cite the justification than non-adopters, with the exception that “Evidence from medical literature” was more commonly cited by those who did not suggest or prescribe ivermectin (76%) compared with those who did (59%) Asterisks indicate statistically significant differences between groups after multiple comparison correction (*** p < 0.001, ** p < 0.01, * p < 0.05).

Results Compilation

2024-08-16